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Five-Year Cost-effectiveness of Intravitreous Ranibizumab Therapy vs Panretinal Photocoagulation for Treating Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial.
JAMA Ophthalmol. 2019 12 01; 137(12):1424-1432.JO

Abstract

Importance

The DRCR Retina Network Protocol S randomized clinical trial suggested that the mean visual acuity of eyes with proliferative diabetic retinopathy (PDR) treated with ranibizumab is not worse at 5 years than that of eyes treated with panretinal photocoagulation (PRP). Moreover, the ranibizumab group had fewer new cases of diabetic macular edema (DME) with vision loss or vitrectomy but had 4 times the number of injections and 3 times the number of visits. Although 2-year cost-effectiveness results of Protocol S were previously identified, incorporating 5-year data from Protocol S could alter the longer-term cost-effectiveness of the treatment strategies from the perspective of the health care system.

Objective

To evaluate 5- and 10-year cost-effectiveness of therapy with ranibizumab, 0.5 mg, compared with PRP for treating PDR.

Design, Setting, and Participants

A preplanned secondary analysis of the Protocol S randomized clinical trial using efficacy, safety, and resource utilization data through 5 years of follow-up for 213 adults diagnosed with PDR and simulating results through 10 years.

Interventions

Intravitreous ranibizumab, 0.5 mg, at baseline and as frequently as every 4 weeks based on a structured retreatment protocol vs PRP at baseline for PDR; eyes in both groups could receive ranibizumab for concomitant DME with vision loss.

Main Outcomes and Measures

Incremental cost-effectiveness ratios (ICERs) of ranibizumab therapy compared with PRP were evaluated for those with and without center-involved DME (CI-DME) and vision loss (Snellen equivalent, 20/32 or worse) at baseline.

Results

The study included 213 adults with a mean (SD) age of 53 (12) years, of whom 92 (43%) were women and 155 (73%) were white. The ICER of the ranibizumab group compared with PRP for patients without CI-DME at baseline was $582 268 per quality-adjusted life-year (QALY) at 5 years and $742 202/QALY at 10 years. For patients with baseline CI-DME, ICERs were $65 576/QALY at 5 years and $63 930/QALY at 10 years.

Conclusions and Relevance

This study suggests that during 5 to 10 years of treatment, ranibizumab, 0.5 mg, as given in the studied trial compared with PRP may be within the frequently cited range considered cost-effective in the United States for eyes presenting with PDR and vision-impairing CI-DME, but not for those with PDR but without vision-impairing CI-DME. Substantial reductions in anti-vascular endothelial growth factor cost may make the ranibizumab therapy cost-effective within this range even for patients without baseline CI-DME.

Trial Registration

ClinicalTrials.gov identifier: NCT01489189.

Authors+Show Affiliations

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor. Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor.Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor. Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.Jaeb Center for Health Research, Tampa, Florida.Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. Editor, JAMA Ophthalmology.Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts. Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. CME Editor, JAMA Ophthalmology.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31647496

Citation

Hutton, David W., et al. "Five-Year Cost-effectiveness of Intravitreous Ranibizumab Therapy Vs Panretinal Photocoagulation for Treating Proliferative Diabetic Retinopathy: a Secondary Analysis of a Randomized Clinical Trial." JAMA Ophthalmology, vol. 137, no. 12, 2019, pp. 1424-1432.
Hutton DW, Stein JD, Glassman AR, et al. Five-Year Cost-effectiveness of Intravitreous Ranibizumab Therapy vs Panretinal Photocoagulation for Treating Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol. 2019;137(12):1424-1432.
Hutton, D. W., Stein, J. D., Glassman, A. R., Bressler, N. M., Jampol, L. M., & Sun, J. K. (2019). Five-Year Cost-effectiveness of Intravitreous Ranibizumab Therapy vs Panretinal Photocoagulation for Treating Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmology, 137(12), 1424-1432. https://doi.org/10.1001/jamaophthalmol.2019.4284
Hutton DW, et al. Five-Year Cost-effectiveness of Intravitreous Ranibizumab Therapy Vs Panretinal Photocoagulation for Treating Proliferative Diabetic Retinopathy: a Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol. 2019 12 1;137(12):1424-1432. PubMed PMID: 31647496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five-Year Cost-effectiveness of Intravitreous Ranibizumab Therapy vs Panretinal Photocoagulation for Treating Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial. AU - Hutton,David W, AU - Stein,Joshua D, AU - Glassman,Adam R, AU - Bressler,Neil M, AU - Jampol,Lee M, AU - Sun,Jennifer K, AU - ,, PY - 2019/10/28/pubmed PY - 2019/10/28/medline PY - 2019/10/25/entrez SP - 1424 EP - 1432 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 137 IS - 12 N2 - Importance: The DRCR Retina Network Protocol S randomized clinical trial suggested that the mean visual acuity of eyes with proliferative diabetic retinopathy (PDR) treated with ranibizumab is not worse at 5 years than that of eyes treated with panretinal photocoagulation (PRP). Moreover, the ranibizumab group had fewer new cases of diabetic macular edema (DME) with vision loss or vitrectomy but had 4 times the number of injections and 3 times the number of visits. Although 2-year cost-effectiveness results of Protocol S were previously identified, incorporating 5-year data from Protocol S could alter the longer-term cost-effectiveness of the treatment strategies from the perspective of the health care system. Objective: To evaluate 5- and 10-year cost-effectiveness of therapy with ranibizumab, 0.5 mg, compared with PRP for treating PDR. Design, Setting, and Participants: A preplanned secondary analysis of the Protocol S randomized clinical trial using efficacy, safety, and resource utilization data through 5 years of follow-up for 213 adults diagnosed with PDR and simulating results through 10 years. Interventions: Intravitreous ranibizumab, 0.5 mg, at baseline and as frequently as every 4 weeks based on a structured retreatment protocol vs PRP at baseline for PDR; eyes in both groups could receive ranibizumab for concomitant DME with vision loss. Main Outcomes and Measures: Incremental cost-effectiveness ratios (ICERs) of ranibizumab therapy compared with PRP were evaluated for those with and without center-involved DME (CI-DME) and vision loss (Snellen equivalent, 20/32 or worse) at baseline. Results: The study included 213 adults with a mean (SD) age of 53 (12) years, of whom 92 (43%) were women and 155 (73%) were white. The ICER of the ranibizumab group compared with PRP for patients without CI-DME at baseline was $582 268 per quality-adjusted life-year (QALY) at 5 years and $742 202/QALY at 10 years. For patients with baseline CI-DME, ICERs were $65 576/QALY at 5 years and $63 930/QALY at 10 years. Conclusions and Relevance: This study suggests that during 5 to 10 years of treatment, ranibizumab, 0.5 mg, as given in the studied trial compared with PRP may be within the frequently cited range considered cost-effective in the United States for eyes presenting with PDR and vision-impairing CI-DME, but not for those with PDR but without vision-impairing CI-DME. Substantial reductions in anti-vascular endothelial growth factor cost may make the ranibizumab therapy cost-effective within this range even for patients without baseline CI-DME. Trial Registration: ClinicalTrials.gov identifier: NCT01489189. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/31647496/Five_Year_Cost_effectiveness_of_Intravitreous_Ranibizumab_Therapy_vs_Panretinal_Photocoagulation_for_Treating_Proliferative_Diabetic_Retinopathy:_A_Secondary_Analysis_of_a_Randomized_Clinical_Trial_ DB - PRIME DP - Unbound Medicine ER -